August 1

There’s less than 3 weeks left before school starts. I finished my last day of work, handed in my garage key card, cancelled my gym membership, and transferred my address from NYC to Michigan this past week. I’ve met with several friends for the last time before I move. I folded all my clothes and placed them into the suitcases. When I looked up and saw a blank white space, my vision started to get blurry and I felt a stream run down my face. I knew this day would come and I’m more excited than anything. 

What I learned and experienced over the last 8 years in NYC is tremedous and something that I would’ve never expected. Sometimes it’s still hard to believe that I’m actually leaving this place now and who knows when I’ll come back. 

Probably the most important thing I found out recently was that I was able to receive in-state tuition, after a 3 month queue and submitting my and my parent’s tax plus more information. 

Anyways, that’s it for now. 

What is Delirium? The ABCDE Bundle

According to my fiancé (yes we got engaged! And yes, he’s not a healthcare guy. In fact, he’s scared of needles), when he hears the word delirium, he thinks of someone being delirious or confused. Unfortunately, this state happens a lot in the ICU and causes a lot of problems.

You can go from being a crazy beast, pulling everything to being super quiet, not making eye contact to someone’s voice. What are the potential causes of delirium and what interventions can be done? Use THINK.

 

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The Gold Standard to determine’s someone state is called the RASS score, or the Richmond Agitation-Sedation Scale. It goes from +4 to -5, as listed below. In conjunction with this, utilizing the Confusion Assessment Method for the ICU (CAM-ICU) determines if delirium is present.

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A lot of times we are using medications for agitation and sedation but studies are showing that using multiple non pharmaceutical methods decreased delirium by 15%.

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In the article, the evidence shows the following will help prevent delirium:

  • Early mobilization.
  • Frequent reorientation.
  • Clinical status updates and schedules.
  • Discuss patient requiring memory recall.

To me, when I read that list, I think most of it is pretty easy. Except for early mobilization. From what I’ve heard, there are patients who are intubated sitting in a chair! In my current ICU, that does not happen. The biggest concern is the stability of the patient. So what can we do?

Implement the ABCDE Bundle,

which stands of Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility. It incorporates the best available evidence related to delirium, immobility, sedation/analgesia, and ventilator management in the ICU. For the ABC Bundle, the nurse and respiratory therapist will go through his or her checklist before the trial.

A stands for Awakening.

The first step is to see if the patient can undergo a Spontaneous Awakening Trial (SAT). The nurse assesses these qualities:

  1. Is patient receiving a sedative infusion for active seizures?
  2. Is patient receiving a sedative infusion for alcohol withdrawal?
  3. Is patient receiving a paralytic agent (neuromuscular blockade)?
  4. Is patient’s score on the Richmond Agitation Sedation Scale (RASS) >2?
  5. Is there documentation of myocardial ischemia in the past 24 hours?
  6. Is patient’s intracranial pressure (ICP) >20 mm Hg?
  7. Is patient receiving sedative medications in an attempt to control intracranial pressure?
  8. Is patient currently receiving extracorporeal membrane oxygenation (ECMO)?

If the answer is yes to any of the above, then there needs to be a discussion with the interdisciplinary team before performing a SAT. If the answer is no to all of the above, then proceed with performing the SAT. Stop the sedation. If the following occurs, you should put the patient back on sedation but try at 1/3 to 1/2 the rate the patient was on before.

  1. RASS score >2 for 5 minutes or longer
  2. Pulse oximetry reading <88% for 5 minutes or longer
  3. Respirations >35/min for 5 minutes or longer
  4. New acute cardiac arrhythmia
  5. ICP >20 mm Hgb
  6. 2 or more of the following symptoms of respiratory distress:
    • Heart rate increase 20 or more beats per minute
    • heart rate less than 55 beats per minute
    • use of accessory muscles, abdominal paradox, diaphoresis, dyspnea

If possible, changing the sedation from propofol to precedex will help patient be calm and it does not depress respiratory status (especially after 24 hours).

B stands for Breathing.

Spontaneous Breathing Trials (SBT) are up next. The respiratory therapist will assess for safety.

  1. Is patient a long-term/ventilator-dependent patient?
  2. Is patient’s pulse oximetry reading <88%?
  3. Is patient’s fraction of inspired oxygen (FIO2) >50%?
  4. Is patient’s set positive end-expiratory pressure (PEEP) >7 cm H2O?
  5. Is there documentation of myocardial ischemia in the past 24 hours?
  6. Is patient’s ICP >20 mm Hg?
  7. Is patient receiving mechanical ventilation in an attempt to control ICP?
  8. Is the patient currently taking vasopressor medications?
  9. Does the patient lack inspiratory effort?

If the answer is yes to any of the above, then it may not be safe to perform the SBT. If the answer is no to all of the above, then the SBT is performed. However, if any of the below occurs indicating signs of failure, then stop.

  1. Respiratory rate >35 breaths per minute for 5 minutes or longer
  2. Respiratory rate <8/min
  3. Pulse oximetry reading of <88% for 5 minutes or longer
  4. ICP >20 mm Hg
  5. 2 or more of the following symptoms of respiratory distress
    • Use of accessory muscles
    • Abdominal paradox
    • Diaphoresis
    • Dyspnea
    • Abrupt changes in mental status
    • Acute cardiac arrhythmia

And of course, who is watching for these symptoms? The registered nurses.

 

C stands for Coordination.

This refers to the coordination mostly between the respiratory therapist and the nurse, although the discussion during the interdisciplinary team will also play a part.

 

D stands for Delirium.

THINK about the causes, use the RASS score every 4 hours and the CAM-ICU score every shift.

 

E stands for Early Mobility.

What I’m interested in is the minimum criteria for early mobility protocol.

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However, if there’s any patient distress, then it’s time to stop. Below are the criteria for stopping early mobility.

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 It’s hard to start something new as an individual as it requires a cultural change and the healthcare team to be behind it. 

But maybe the next time you take care of a ventilated patient, you’ll think of the ABCDE bundle and implement it as a part of your care. 

 

NYU Accelerated Nursing Program FAQ’s Part II

I recently received an email from a prospective nursing student and thought that it was worth posting my answers.

Hi Jessica,
I came across to your blog while searching for NYU’s accelerated nursing program.  Reading your blog has been very helpful. Congrats on becoming a nurse. Currently I have my undergrad in a business discipline and I am really considering a nursing career instead. I just have some questions regarding nursing, it would be great to get your feedback. Thanks so much if you have the time to answer any of these questions!

1.       Does it matter whether you take your pre-reqs at a community college or 4-yr college when applying to NYU? Do pre-req grades matter? Will there be a higher chance if acceptance if pre-reqs are taken in NYU?

You can take your pre-reqs at a community college or a 4 year college. Pre-req grades matter a lot. Definitely do well on these. I don’t believe there’s a higher chance of acceptance of the pre-reqs are taken at NYU. Majority of students take pre-reqs at a community college or a 4 year college.


2.        What were your credentials when you applied to NYU (eg. GPA, experience)? And did you find NYU to be worth it after working in the field? Is there any other nursing programs you would recommend in NY?

My GPA was 3.84. As for experience, I volunteered at a hospital when I was applying. It’s important to highlight your feelings towards nursing especially after speaking to them and seeing what they do.
NYU is a great school and I’m glad I attended the school. The professors are top-notch and the students are helpful. There’s an interdisciplinary program so med students and nursing students learn about working together and each other’s roles. It is one of the top research institutions as well especially in elder care (NICHE Program http://www.nicheprogram.org). However, it is a really expensive program so I don’t recommend it to everyone.
The other nursing schools in New York / Long Island that I hear good things from include Hunter, Columbia, Stony Brook, Adelphi, Molloy and Pace.

3.       Difficulty finding a job? Did you work part-time while studying in the program?

After I passed the NCLEX, it took about 6 months to find a nursing position. A couple of problems I ran into included not knowing how to interview (because this is a skill you need to practice). I didn’t start my search until after I passed. Some students connected with nurse managers during clinical and were able to secure a position shortly after graduation.

I did work once a week as a swim instructor during school to help supplement the costs. Some students didn’t work at all while others worked 36 hours a week (a full-time job!!). The first and second semester are the toughest so give more time devoted to school before deciding to work.

4.       Do grades matter a lot to employers? Do I need to get straight A’s or can I afford to have a few B’s or even a C?

Some employers require a minimum GPA (3.4, 3.5) before they even look at your application. Some don’t. It’s how you present yourself and your mannerism that matter and whether you retained information from school and can apply it.


5.       What is the starting salary like and is it worth being a nurse practitioner? What kind of nurse do you think is best to become/specialize in if any?

Starting salary differs from location to location, ranging from $40-80k. In NYC, it starts around $70-80k if you’re working at a private hospital.

Becoming a NP is dependent on the person. While I’ve heard that becoming an NP is the greatest thing in the world (I hear a lot of positive feedback), there are still a few who are discontent with the position, as there is more responsibility that comes with the position. Some people don’t want to deal with the higher stress and responsibility but wanted to go back to school and ended up hating being an NP. This requires a lot of self-reflection. What do you think would suit you and are you ready for it?
Personally, I’ve explored many advanced nursing professions. Not only should you look at your duties but also the lifestyle. Where would you want to work, what would you do, when would you want to work, what income would you make, what mobility is there? The best advanced nursing profession depends on the individual and what they want out of life. I picked Certified Registered Nurse Anesthetist. I like the one-on-one direct patient care aspect requiring a high level of critical thinking and autonomy and teamwork.

6.       What’s life as a nurse? What are the difficulties and good parts of being a nurse? Expectations in the work force?

Life as a nurse differs between the environment that you work in. I work at the hospital where there’s 12 hour shifts (7-7:30am and pm), 3 days a week (for full time) and you can choose your schedule (with some limitations such as having to choose at least 3 weekend days, 2 Fridays, etc). Some people choose to do 3 in a row each week and have 4 days off. Other hospitals have it so you work 3 12-hour shifts plus 1 additional day every 4 weeks. Some units, especially in CTICU, PACU and ER, have other shifts from 11am to 11pm or 2pm to 2am.

It’s great having 4 days off because you definitely need it to recuperate and you’ll have time to do something else if you’d like.
Some places have day (7a -3p), evening (3p-11p), and night shift (11p-7a), especially in rehab and nursing homes, and require you work 5 days a week.
At work, you often need to have handoff communication about the patients. Then you assess the patient and pass out medications. You make nursing diagnoses about each patient and use critical thinking. You think to yourself: What’s the goal for the patient today? And then make it happen. You’ll speak to various disciplines to coordinate the care.
There’s a couple of tough parts about being a nurse.
1) Families – Some follow the unit policies and others do whatever they want. Communication is sometimes hard but trying to understand where they are coming from helps.
2) Physicians, MLP – your input is often crucial to the patient’s outcome but sometimes the provider will disagree with you.
3) Patients – some are nice and others are crazy, confused and not so nice.
4) Self- being able to let go everyday of the outcome is tough. At the end of the time, you have to set 1 small goal for the patient and as long as they meet that, you have to be satisfied with the care you provided. Nurses tend to be overachievers and want to always give more but with the number of things that must be done, it’s impossible to do everything you had in mind. You have to remember that nursing is a 24/7 job.
The good parts about being a nurse is knowing that you’ve made a difference is someone’s life. You get to think about an active problem and you get to take yourself and solve that problem. You get to hold someone’s hand and reassure them. It’s an amazing privilege to have to save a life, to have a better life, or to let someone die with dignity.
As for expectations in the workforce, there are several different angles you can discuss but I’ll discuss about your own expectations. There’s a nursing theorist named Patricia Benner who stated that the nursing career is based on the nursing model-
You really do start not knowing a lot, just the basics. You focus a lot on technical skills because it’s something you have to work on. Then as you progress, you build more confidence. Soon you’ll start to see areas in nursing where care can be streamlined or have protocols to standardize care. You’ll be in charge, take on harder assignments, be a preceptor, etc.

7.       Any general suggestions on what I should focus on or do to become a nurse/get into NYU program?

Do well on your pre-reqs, volunteer or work in healthcare, and get to know a few professors who will write a letter of recommendation for you. And write a killer personal statement answering every question asked.

I hoped that helped! Read my first post for more information on NYU’s Accelerated Nursing Program, find out if NYU Nursing is worth it, how to pick a good nursing school, and find out if you can afford an accelerated program. Or if you have any further questions, email me.

Jessica

The Second Career Nurse [Infographic]

While there’s a lot of people who say that nursing was all they ever wanted to do, there’s also a lot of people who doubled back and thought otherwise (including myself!). There are many barriers to commit nursing as a number one career choice. One of the biggest hurdles is our conformity to society. What do our parents, family, friends, and society think about our career choice?

I know personally that I had pressure. I know many male nurses receive a certain pressure too. I know that many immigrants who may look down on nursing get that pressure. Even patients will ask, why nursing?

People get an image in their head and continue to apply that to everyone. A female should be a nurse, a male should be a doctor, some immigrants may think nursing is not a noble profession but rather a dirty one (mostly because of how the nursing profession is portrayed in other countries). We have to break free of these stereotypes and see nursing for what it really is.

Nursing is one of those fields where you get to make a difference in someone’s life everyday– where you combine the science and the art. You will make sure that someone will receive the best possible care, and in the safest way. And when that doesn’t happen, you will start an investigation questioning why that is and what can be done differently.

When we start to have a diverse group of nurses, different ideas abound, different strengths surface, and as a whole, nursing gets stronger.

You can jump over these hurdles by thinking about what is nursing, and how nursing is such an amazing and vast field. There are so many choices and different ways you can contribute, touch another and be touched. You can in one direction and go up as high as you want, or expand horizontally and try out different fields of nursing. You can choose to be by the bedside, or an administration, in research, in an insurance company, etc. Wherever you decide to grow, just go for it. Say it out loud and proud and you will gain social support.

I got in touch with the author of the Top RN to BSN website, who suggested that I include this infographic below on the Second Career Nurse. She did her research and learned more about the characteristics of the Second Career Nurse. I thought it was informative so here it is! If you look at the graph below, you will see that in 2012, 1 in 3 nursing grads are from accelerated nursing degrees.

Now, I have some questions for you as the reader. What made you change your career and how did you get your support for switching into nursing? Comment below to start a discussion. I look forward to chatting with you.

Jess

 

Second career nurses are solving the nursing crisis.

Source: The Second Career Nurse

 

Project GLAM – Start Your Own Dress Donation Drive

project glam

As a part of our unit’s community service project, we decided to do two projects. One of them was Project GLAMGranting Lasting Amazing Memories. Somehow I was assigned to make the flyer and ended up becoming the head cheerleader for this project. WGIRLS Inc started Project GLAM back in 2010 where you can donate your gently used prom dresses (or cocktail dresses or bridesmaid dresses) for underprivileged girls who need prom dresses!

The idea started back in January by my nurse manager where she handed me some printouts from the website. Even Oprah endorsed it, how can you go wrong?

I made the flyer and started talking about it with coworkers a week before our donation drive. I set the drive to a short amount of time (2 weeks) so that people who were interested would bring in their dresses right away. I thought the flyer should be colorful and have spring colors, as well as the logo of the project. The timing of the drive is also important — it just turned spring, just in time for spring cleaning and Earth Day (reduce, reuse, recycle!), and it is before prom session starts. The Project GLAM was also discussed in the local news, which helped bring interest.

It was exciting talking to people about it, and hearing others talk about it with others. There’s a large age range of those working on the unit so many had different ideas of which dresses they should donate — some brought their own cocktail dress or bridesmaid dress, and others brought their own daughter’s prom dress!

We collected about 10 dresses and many accessories. Next, I got in touch with Amy, the president of WGIRLS, who then put me in touch with Kristi, the VP of WGIRLS in Long Island. We decided on a location and I dropped off the dresses.

Overall, it was a successful drive and I hope that other organizations will do the same! It helps to have a group of people donating to bring a sense of community together. However, if you’re interested in donating your own dresses, drop off your dress and accessories at these locations.

Have fun with your own dress drive and make a difference. 🙂

Low GPA, can I still get in?

Hi!

I recently received an email regarding low GPAs (as defined by anything less than 3.0) and what can be done about it, especially if you’re interested in heading back for an accelerated BSN degree or graduate school. After a little research and discussion I found out a few things that I thought may be helpful to share.

If you already have a BSN degree and you have a low GPA, then there are a couple of options you can take. These may or may not count towards the undergraduate GPA, but it will demonstrate to the admissions board your dedication, motivation, determination and persistence.

  1. Take non-degree courses at universities.
  2. The University of Phoenix offers certificate courses meant for post-BSN and not as a full blown MSN program.
  3. Apply and get enrolled into a MSN program that doesn’t require stellar GPAs and that allows you to go part-time. Take core classes that could transfer to your dream school and ace those classes.

Many hospitals offer compensation for nursing credits so be sure to take them up on the offer. Get to know the details of the offer. At my hospital, only those working night shift can get it and then must work 1 year after they have taken the class. They must get a certain grade. Other hospitals may have requirements of you working for the hospital for an ‘x’ number of years.

I hoped that helped! Let me know if there’s anything different that you’ve done.

Jessica

I got into the University of Michigan-Flint / Hurley Medical Center Nurse Anesthesia Program!

official.umflint.logo_I’m really excited to say that I got into the University of Michigan-Flint / Hurley Medical Center Nurse Anesthesia Program. I am proud of my accomplishments and thankful for everyone who has encouraged me and helped me along the way.

I’m inspired to write about my journey — past, present, and future — by other blogs about Certified Registered Nurse Anesthetists (CRNA) schools (such as http://studentcrna.blogspot.com/ and http://lifectent.blogspot.com/) and the Umich Med School blog written by multiple students. My hope is to give insight into this career path and encourage those who may be interested too.

Like many others, I have varied interests, but healthcare was always in the forefront of my mind. I grew up knowing that I wanted to heal the sick and that I wanted my presence to truly make a difference in people’s life everyday.

I first went for a biology degree for pre-med. But unfortunately, as I started to explore medicine as a career, I was put off by it. Sure, a lot of friends continued on and I’m proud of them. Some decided that it wasn’t for them either. I started to explore other healthcare fields. I found my place in nursing. I was most excited when I found out about the accelerated nursing programs because it truly changed my life. Before I finished my biology degree, I took several prerequisites for nursing schools that I was interested in (because unfortunately they all differ).

After I graduated from nursing school, I knew that I wanted to go to graduate school. I took a couple of graduate courses through NYU’s dual degree program while I was working on telemetry. I was interested in nearly all the graduate nursing fields — nurse practitioner (acute, primary, pediatric, family), nursing informatics, nursing administration, and nurse anesthesia. But it wasn’t until I entered the intensive care unit before I started to really take my preparation seriously. At this point, I debated becoming a primary NP or going into nursing informatics or nurse anesthesia.

I already saw what a difference nurse practitioners do but I didn’t know if I really had it in me to do anesthesia. Life in my hands– day in and out. But I met a few UM alumni who told me that I would do a great job. I shadowed them over the summer, and saw their autonomy and teamwork abilities. I had almost all of the credentials to apply and their encouragement made me believe in myself.

I started my process of looking into schools to apply.

  1. Where is it located?
  2. Do I meet the requirements? If not, which ones are still missing?
  3. Is there an information sessions to learn more about the program?
  4. When is the due date? When does it start? How much does it cost?

I started attending information sessions in July. I went to UM-Flint information session in October. My advice is to bring transcripts. This kills two birds with one stone — (1) an opportunity to speak to the head of admissions and (2) to find out if your prerequisites meet the school’s standard. Learn how the school chooses students. Some may emphasize that three years of critical care experience is essential and any ‘outside of work’ experience is crucial. Others say that ‘you may pass all of the didactic courses but if you fail the clinical aspect, then you’re not cut out for CRNA.’ While that’s true, when I hear that comment, I feel that the school is more hostile rather than helpful. Just as you’re interested in becoming a CRNA, it is important to learn more about the school’s culture.

At the University of Michigan-Flint, admissions is based on a points system (as are many schools). For the application, objective data such as the science GPA, overall GPA, and GRE score is scored. Thankfully, I was able to submit majority of the application before tackling the admissions essay. In the essay, it is crucial to answer every question in detail. And while the CCRN is not required, it is highly recommended to take it. It shows that you take your education seriously and it helps you prepare for the interview.

At UM-Flint, there are 2 due dates: Early (10/1) and Regular (2/1). I submitted my full application a week before the due date. There was a website to check if all of your required paperwork is submitted and which ones were not completed (I loved this!). The admissions team was easy to work with and answered all my questions. Sometime during the first week of February, I was offered an interview for either February 19 or 20. I picked Friday the 20th. I made some work schedule changes and booked a flight back home. The 3 part interview (exam, panel interview, and OR with CRNA) is also based on a point system– 10 points for each section. The purpose of this is to make admissions as fair as possible (rather than getting in because you know someone on the admissions board).

  1. The exam is composed of multiple choice, fill in the blank, and essay comprising mostly of CCRN and ACLS material. Apparently, I have to work on the cardiac section.
  2. The interview is a panel interview asking typical questions as well as some ethical questions. I highly recommend practicing saying them out loud. I recommend getting the All CRNA School Guide, going over common questions.
  3. The OR time with a CRNA is comprises of short clinical questions on what you’d do in certain situations.

When I walked in, I saw that I was the last person to be interviewed. After the 3 hour interview window, I was driving back home and got the call. I was shocked that they had reached their decisions so quickly, especially since I was expecting to hear back a week or two after the interview. It may be because they’ve already interviewed everyone and scored them on a points system already and they simply picked people starting from the highest marks going down the list. But regardless, I was definitely excited.

Of course, getting in sparked another list of questions to solve. That’s what I’ve been working on since then.

  1. Where will I live?
  2. Who will I tell?
  3. When is my end date at work?
  4. How will I end my lease?
  5. How will I manage my relationship with my sister and boyfriend?
  6. Will my boyfriend stay here or move back with me?
  7. My car lease is almost up. Should I lease or buy another car considering the number of miles I will potentially drive?
  8. Taxes need to be completed. FAFSA needs to be completed. In-state or out-of-state residency needs to be determined.

I also looked up all the clinical sites and put them on Google Maps.

It’s about a nice 1 hour radius circumference from Flint, Michigan. As of right now, I’m planning to stay at home in Ann Arbor but for clinical that is more than 1 hour away, I’ll stay closer.

As for my boyfriend, he will stay in NYC. He’s doing well with his career here. And we’ve had a long distance relationship before back when we were swapped — when he was at the University of Michigan studying economics and I was in NYC. How ironic.

As for cars, lately I’ve leased Honda Civics because they are less expensive and reliable. But it is true — I really should support American Car Companies (Ford, GM, Chrysler). I plan on going to the New York Auto Show in April and hopefully I’ll get a better idea of what car I should buy.

As for saving money for tuition, I’ve been working an extra shift about every other week. Thankfully I’ve saved a bit already in my retirement funds, which can be used for higher education (I need to look into this more).

As for the order in which I told people, I first told my closest friends not from work. Then after the official letter came in, I told my nurse manager (who is really supportive!!). After that, I put it on Facebook. Prior to applying, I didn’t make it well-known that I was interested in nurse anesthesia partly because I wasn’t sure of the reactions I would receive and I’d rather just leave that part off the table. However, since getting in, I’ve received positive feedback. I think that for the most part nurses are kind and encouraging but I guess you never know.

That’s it for now.

 

 

National Certified Nurses Day

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On Thursday, March 19, was National Certified Nurses Day. At work, it was nice to get that acknowledgement (again!). The AACN ambassadors put together little bags for all those who are certified as a CCRN. In the bag, there were a couple of AACN and CCRN pens, pins, and chocolate.

My hope is that once you’ve been in practice long enough to get certified, go for it. It just gives you that additional “oomph” and confidence.

 

Nurse Blog Guidelines

Hi nurse bloggers or future nurse bloggers,

You’re probably coming across this page because you’re interested in blogging, or writing your experiences, as a nurse.

Blogging is a great way to:

  • Reflect on the day you had and how you can do better
  • Share your experiences with other nurses

Personally, I feel compelled to write about my experience because I get really drawn into other people’s blogs when they describe their story and figured others feel the same way. However, many times people remain anonymous about themselves, the school they’ve gone to, and their workplace. They often do things for a few reasons:

  • Fear of attention
  • Fear of consequences
  • Horror stories of nurses getting fired for breach in privacy and confidentiality

Of course, I don’t want repercussions for displaying the wrong information. Before I started writing, I did some searches on social media guidelines, but a lot of them are not specific. To shorten the mumble jumble, I’ve consolidated the pages of guidelines to 3 things.

  1. Comply with HIPPA. Don’t use any identifiable information such as a name, specific age, race, specific health condition, specific surgery, address, room number, family members, specific doctors, etc. One way to overcome this barrier is to switch names or if you’ve had similar patients, merge experiences you’ve had together.
  2. No pictures with patients or the hospital without written consent. Don’t take any pictures and don’t post them anywhere unless you have received permission. Even if you have received permission, it is best to show something in the positive light.
  3. Be positive. Writing negative things about specific people such as patients and coworkers is really easy to do (it’s hard not to complain). However, whatever you write will stay on the internet forever, even if you delete the information later on. It is better to deal with negative things with people one on one. While it is true that things don’t change unless you bring up what is ‘bad’ or ‘wrong’, it does not mean complaining about it on the net is any better.

So what are topics that you can discuss?

  1. One way to discuss something negative though is to discuss an issue or a problem, and suggest ways to abolish the problem or improve a system. There are many issues that need solutions. That is how we improve healthcare!
  2. Your conversations with patients and family, and the healthcare team.
  3. What you learned from a situation.
  4. Connecting what you see in the field, what you read in textbooks and journals, and what theories apply.

If you would like more details, I recommend reading the Online Journal of Nursing and the National Council of State Board of Nursing for Social Media Guidelines.